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General NPI Number Information
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NPI Number | 1255088274
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Entity Type | Organization
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Legal Business Name | VILLAGE FAMILY DENTAL LLC
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Dates
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Enumeration Date | 03/09/2022
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Last Update Date | 03/09/2022
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Provider Practice Location Address
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Address Line | 449 PLEASANT HILL RD NW STE 101
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City | LILBURN
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State | GA
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Zip | 30047-2770
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Country | US
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Telephone | 770-797-5228
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Fax | 678-587-5910
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Provider Business Mailing Address
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Address Line | 449 PLEASANT HILL RD NW STE 101
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City | LILBURN
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State | GA
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Zip | 30047-2770
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Country | US
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Telephone | 770-797-5228
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Fax | 678-587-5910
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Authorized Official
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Title or Position | DENTIST
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Name | DR. HANNAH CLIFFORD
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Credential | DDS
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Telephone | 770-797-5228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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